Cao Xiuhong, Luo Ye, Zhou Shuangqiong, Zhao Qingsong, Qin Xuewei, Liu Zhiqiang, Xu Zhendong
Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Research and Education, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Med (Lausanne). 2022 May 25;9:876411. doi: 10.3389/fmed.2022.876411. eCollection 2022.
In recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section.
This retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted.
The overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05-2.51, = 0.031; AOR = 1.71; 95% CI, 1.08-2.70, = 0.022; AOR = 1.98, 95% CI, 1.21-3.25, = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04-2.82, = 0.036; OR = 1.90, 95% CI, 1.13-3.21, = 0.016; OR = 2.48, 95% CI, 1.41-4.38, = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies.
Growth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.
近年来，全球产后出血的发生率有所上升。多胎妊娠和剖宫产是众所周知的产后出血危险因素。尚无研究评估剖宫产双胎妊娠妇女胎儿生长异常与产后出血之间的关联。本研究旨在确定剖宫产双胎妊娠妇女胎儿生长异常与产后出血之间的关系。
这项回顾性单中心研究纳入了2013年8月至2020年7月期间在一家三级医院的3180例双胎妊娠妇女。使用单胎参考图表评估出生时的胎儿生长受限情况。生长不一致定义为双胎出生体重差异≥20%。采用逻辑回归分析评估胎儿生长异常与产后出血之间的关联。此外，还进行了胎盘异常的敏感性分析以及按双胎绒毛膜性分层分析。
产后出血的总体发生率为4.3%。双胎生长不一致，尤其是伴有胎儿生长受限，与产后出血风险增加相关（校正比值比[AOR]=1.62，95%置信区间[CI]，1.05 - 2.51，P = 0.031；AOR = 1.71；95% CI，1.08 - 2.70，P = 0.022；AOR = 1.98，95% CI，1.21 - 3.25，P = 0.006）。分层后，这种关系在双绒毛膜双胎中持续存在（OR = 1.71，95% CI，1.04 - 2.82，P = 0.036；OR = 1.90，95% CI，1.13 - 3.21，P = 0.016；OR = 2.48，95% CI，1.41 - 4.38，P = 0.002）。然而，在单绒毛膜双胎妊娠中未观察到显著关联。
生长不一致，尤其是合并胎儿生长受限，与剖宫产双胎妊娠妇女产后出血风险增加相关，且在双绒毛膜双胎患者中更为明显。
